GLP-1s and workforce health: Obesity, Ozempic, and overwhelming unknowns

GLP-1s for obesity: Promising results — and a lot of unknowns

GLP-1s may be new to mainstream media, but they’re not new to the health care industry. The first one was approved by the FDA in 2005 to treat type 2 diabetes.⁵ Over time, researchers observed side effects — namely, decreased appetite and weight loss. Fast-forward to today, and millions of people are using GLP-1s to lose unwanted pounds. Prescriptions increased 300% between Q1 2020 and Q4 2022 — and now only 54% are prescribed to treat type 2 diabetes.⁶

People can lose 15% to 20% of their body weight on GLP-1s⁷

That kind of weight loss can help employees manage — and even reverse — many chronic diseases that go beyond diabetes, including high cholesterol, high blood pressure, and more.

There’s growing concern about negative — and unknown — impacts

Despite the overwhelming demand for new GLP-1 prescriptions for weight loss, more than 2 in 3 people stop taking them within the first year.⁹

• More than 82% experience mild to moderate gastrointestinal side effects.¹⁰
• Users have 4 times greater risk for stomach paralysis and bowel obstructions and 9 times greater risk for pancreatitis.¹¹
• Up to 40% of the weight people lose on GLP-1s is actually lean muscle mass, not fat.¹²
• Researchers are looking into the possibility that GLP-1s could increase depression and risk for suicide in some patients.¹³

“We have a pretty good understanding of the short-term consequences of GLP-1s for weight loss. But long term, we really don’t know. And that’s where my concern lies,” says Sean Hashmi MD, MS, FASN — regional physician director of lifestyle and obesity medicine at Kaiser Permanente. “For example, in patients who rely on food for comfort, taking a GLP-1 blocks those reward pathways in the brain, and they could become depressed.”

Are GLP-1s being prescribed safely and responsibly?

We clearly don’t know enough about GLP-1s for weight loss yet to prescribe them to everyone who wants them — but everyone seems to want them. In fact, 3 in 5 Americans trying to lose weight are interested in taking GLP-1s.¹⁸ And as employers struggle to balance workforce demand with responsible benefits spending, GLP-1s are emerging as a powerful recruitment and retention tool:

• Twenty percent of employees would change jobs to get GLP-1 coverage.¹⁹
• Employees rank GLP-1 coverage as more important than other highly coveted benefits, like child care reimbursement, unlimited paid time off, and flexible work arrangements.²⁰

Questions about supply, demand, ethics, and equity

Ongoing shortages have raised questions about who should have access to GLP-1s — and ensuring availability for people who truly need them. But many virtual, direct-to-consumer companies are aggressively marketing GLP-1s for weight loss and selling prescriptions with little, if any, medical oversight. In fact, only 53% of new GLP-1 prescriptions in the U.S. are associated with a doctor visit.¹

Experts also worry that the media frenzy surrounding these drugs could be harmful to people with eating disorders by reinforcing cultural ideals around thinness. And finally, most employees can’t afford to pay for these expensive drugs out of pocket, which could eventually widen the health equity gaps we already see around obesity.

Provide comprehensive weight management support

GLP-1s should never be the first line of defense for weight management and should only be considered in conjunction with personalized physical, mental, and social health support. This could include things like counseling, nutrition education, digital tools, employee support groups, and subsidized fitness classes.

As Dr. Hashmi notes, “These medications are not substitutes for eating better, exercising, managing stress, and prioritizing sleep.” Considering the low adherence and high cost associated with GLP-1s, behavior and lifestyle modifications remain essential to the long-term value of any workforce weight loss strategy.

Choose a health plan with a targeted prescribing approach

Before considering GLP-1 medications, physicians should carefully review each employee’s medical history to understand how weight has impacted their health — and what solutions have been explored before. Then, they should work together to create a holistic and sustainable treatment plan that addresses behavior changes, psychosocial support, and socioeconomic stressors — and may or may not include medication.

Advocate for equitable, evidence-based care

Ask your health plan how their physicians approach GLP-1s. Make sure these drugs are being prescribed to employees with type-2 diabetes and comorbidities, not just those with obesity. And — although this should go without saying — confirm that covered providers only prescribe GLP-1s for weight loss when clinically appropriate.

Emphasize clinical integration and engagement

If your GLP-1 program doesn’t integrate with your overall weight management program, it’s likely not worth the additional cost. Employees need to be educated before they start taking GLP-1s. And they should be carefully monitored by clinicians who are invested in and informed about their patients’ total health. Obesity treatment works best when it can be modified in real time — including discontinuing GLP-1s in favor of more effective medications.